police intercede

[mackeydad]

i just finished reading the blog entitled "policy on refusal of care". in an 18 december, 2007 post, medic511 discusses a recent run he he was on. he was called to the scene of an mva and found the driver ambulating, with no signs of injury. he also had no complaints, pains, and seemed fully competent. you can search patient refusal of treatment, and drop down to policy on refusal of care for a full explanation of the run. he decided the patient had to be transported based on mechanism of injury alone and conferred with the on scene police officer, who then told the patient he had two choices. he could either go the hospital willingly in the ambulance, or in handcuffs with the police. this incident bothers me a great deal. the patient met all the criteria for informed refusal and had certainly committed no crime. in this particular case the patient, when faced with these choices, decided on the ambulance. i have two questions here. what do you think the outcome would be if the patient simply stood his ground and again refused? what gives the police the authority to compel a fully competent patient who had already refused to go to the hospital against his will? i would have chosen the squad car and the handcuffs, and my gut feeling is that both ems and the police would have backed off. am i right or wrong?

[DwayneEMTP]

Man, good questions. There's possibly other variables, though I'm not sure.

If we're dealing strictly with medical ethics, (No legally state mandated drug screen following accidents suspicious accidents, or some such.) then there is no way to justify this behavior.

It's impossible to know what the outcome would be, but my guess would be that the cops would have driven him to the ER. A hell of a lot cheaper than an ambulance, for me, but terribly expensive for the police after they're done legally defending their violation of my civil rights.

Again, assuming that the call has no hidden worm holes, there is no way that this was acceptable. Unfortunately, the person did go voluntarily, and it's unlikely that the police or the ambulance crew will ever 'remember' that conversation taking place...

Would they have backed down? It probably has more to do with the backbone and education of the person they're trying to intimidate...someone timid, it's unlikely, someone more, respectfully, aggressive with an intelligent argument, probably...

[MariB]

Simple case of battery. If he had no altered status. Is making an informed decision to not be transported, he has every right to do so. It is up to the EMTs to document every attempt they made, have the refusals signed and witnessed, preferably by the police, and leave the poor man alone. They had no right to force medical care if he was competent.

[ERDoc]

I would have chosen the cuffs and then retired after the lawsuit. At minimum I'd expect the EMS agency and/or PD to pay for all of the bills associated with it. This is all based on the info presented.

[MikeEMT]

Mackey, I was a former police officer and I encountered this many times as a cop. There are often variables that you are unaware of. Maybe the patient made comments that they want to harm themselves (which you SHOULD be told about but doesn't always happen). Maybe the patient was acting a lot different before your arrival or they are acting different now.

I remember one example where I was the officer investigating a one car MVA with the driver being the sole occupant. Ambulance shows up and starts interviewing the driver who was sober and was for all intents and purposes A&O x4. EMTs were going to AMA him when I interviened. Argument ensued and I basically said something similar to you can go on your own or I will invol you. Patient went to ER on their own and afterwards the EMT's had some choice words for me when I showed up at the ER to complete my report. What they didn't know was I knew the patient and even though he was A&O x4 I knew something was wrong with him. The EMT's failed by asking only standard A&O questions and not going further in their questioning. Had they done so they would have discovered patient was altered. Turns out he had a brain bleed.

So the bottom line is without knowing all the facts, you can't really judge the cop especially when its third party info such as on this forum. However, on the flip side of things, now that I am an EMT I work with our police all the time and more often than not they make me want to pull my hair out and scream. Recently I had a cop get mad at me because I refused to put a suicidal patient in 4 points. I replied to the officer, patient is calm and cooperative for me if that changes I can put them in restraints but you don't arrest people because I tell you to and I don't put people in restraints because you tell me to.

Truth be told police and EMS interaction can be highly difficult.

[Richard B the EMT]

If I were the on scene EMT running the call, I'd involve FIRST the OLMC Doctor, with all VS and observations reported. On request, I'd have the Doc talk to the potential patient. Dependent on the OLMC Doc's recommendation after speaking with the patient, I'd either get the Cop witnessed RMA signature, or the Cop's "Protective Custody" for the patient.

Either way, "document, Document, DOCUMENT!"

(Attention "Newbies": OLMC = On Line Medical Control)

[mackeydad]

Mackey, I was a former police officer and I encountered this many times as a cop. There are often variables that you are unaware of. Maybe the patient made comments that they want to harm themselves (which you SHOULD be told about but doesn't always happen). Maybe the patient was acting a lot different before your arrival or they are acting different now.

I remember one example where I was the officer investigating a one car MVA with the driver being the sole occupant. Ambulance shows up and starts interviewing the driver who was sober and was for all intents and purposes A&O x4. EMTs were going to AMA him when I interviened. Argument ensued and I basically said something similar to you can go on your own or I will invol you. Patient went to ER on their own and afterwards the EMT's had some choice words for me when I showed up at the ER to complete my report. What they didn't know was I knew the patient and even though he was A&O x4 I knew something was wrong with him. The EMT's failed by asking only standard A&O questions and not going further in their questioning. Had they done so they would have discovered patient was altered. Turns out he had a brain bleed.

So the bottom line is without knowing all the facts, you can't really judge the cop especially when its third party info such as on this forum. However, on the flip side of things, now that I am an EMT I work with our police all the time and more often than not they make me want to pull my hair out and scream. Recently I had a cop get mad at me because I refused to put a suicidal patient in 4 points. I replied to the officer, patient is calm and cooperative for me if that changes I can put them in restraints but you don't arrest people because I tell you to and I don't put people in restraints because you tell me to.

Truth be told police and EMS interaction can be highly difficult.

apparently none of the problems you mentioned existed in this case. if you search patient refusals of treatment, click on page 2, and drop down to comments by medic511, you can read his complete comments. as written, the patient simply didn't want to go, met all the legal requirements for informed refusal, and by law, should have been allowed to sign an ama refusal and go about his business. i wonder what might occur in cases like these if this patient had stood his ground and chosen the squad car and handcuffs? have any lawsuits occured in such cases questioning the authority of police to force a patient to go to the hospital against his will when he clearly (at least according to medic511's run report) met ALL legal requirements for informed refusal as set forth in the law?

[Just Plain Ruff]

Both the cop and the EMS Crew would have been named respondents in the lawsuit Mackeydad thats what would have happened. Again, document document document.

[Richard B the EMT]

I should restate:

Document, Document, Document!

[Happiness]

And yes I have used this on the scene to someone that refused transport but did meet criteria through mechanism of injury (only works with men). "If you have injured your spinal cord at all and it is not taken care of you may never have a natural erection again" Works every time

As for the actual post. It is hard to make a good choice just by a forum and not being at the scene. I always encourage my pts to go get checked out, as we do not have x-ray vision to see any injuries. I think in order to answer do we know the outcome. Were there any injuries in the patient?